January 2008
by Vicki Rackner MD
Would you want to live in a town where the fire department only responded to calls from certain select citizens? Where most people thought that installing smoke alarms and changing the batteries was the firefighters' job? Where kids played with matches in plain view and the adults didn't say a word about it?
Guess what, folks? If you think of doctors as the professionals who put out medical fires, you already do! We have 45 million citizens in our American community that have limited access to medical firefighting services because they don't have health insurance. The overwhelming mentality is that it's the doctor's job to do things to us and for us to keep us healthy while we passively stand by. We are raising a generation of increasing numbers of sedentary, obese kids, and the adults are right beside them on the couch passing the chips and ice cream.
All of the presidential candidates will present plans that ensure that everyone has access to the medical firefighters. That's only a partial answer to our health care crisis.
The complete health care solution requires more. It transcends the question of whether we have a single-payer system or what role the government plays in administering it. It can and must include a way for each citizen to take personal responsibility for his or her health so that medical fires are ideally prevented or put out early so that damage is minimized.
I believe that the way individual patients think and feel and act during illness present significant barriers to quality health care. I saw it every day in my years as a practicing surgeon. I call these human factors like embarrassment and fear and outdated medical manners the elephants in the exam room.
You don't need an academic study to know what I'm talking about. All you have to do is think back to your last doctor visit or the last time a loved one was in the hospital. Most people are not able to ask for the same kind of service from their doctors they would expect at a restaurant or from a car mechanic. No matter how successful, enlightened or empowered you are, times of illness come with known human challenges. These challenges can stop you in your tracks, whether you're the patient or you're advocating for your aging parents who have their own elephants.
When I asked a teenager puffing on a cigarette what she thought would happen to her health if she continued to smoke, she said, "Three of my grandparents died of cancer. If I get lung cancer, it won't be for at least 40 years. By then there will be a pill to cure it."
Many people believe that their doctors are gifted with super-human powers. They can predict the number of days remaining in patients' lives, promise good medical outcomes or read the unstated questions in a patient's mind. Most concerning is the patient who believes that doctors can fix any medical problem, including those caused by poor lifestyle choices.
Perhaps most dangerous is the belief that patients hold is that they are powerless to shape their health destiny. While patients overestimate their doctor's power to cure illness, they dramatically underestimate their own ability to shape their own health stories.
These unrealistic beliefs drive up the cost of health care. Unless and until patients understand that their health picture is like a scorecard that tallies their health choices, and doctors are just people, we cannot move towards meaningful change.
President John Kennedy inspired and challenged our nation with the words: “Ask not what your country can do for you; ask what you can do for your country.” This spirit serves us well as we squarely face the task of creating a more functional system of health care delivery. I draw upon my experience as a practicing physician and state with certainty that patients can and will contribute to the solution. They will respond to the call to action, “Ask not what your doctor can do for you; ask what you can do with your doctor.” The candidate that issues this challenge gets my vote.
Copyright © Vicki Rackner MD, 2008
The Answer to the Health Care Crisis Is You